Coexisting Calcific Aortic Stenosis and Transthyretin Cardiac Amyloidosis: Real‐World Evaluation of Clinical Characteristics and Outcomes
Background The coexistence of transthyretin cardiac amyloidosis (ATTR‐CA) and aortic stenosis (AS) is increasingly recognized, but the clinical consequences are unclear. We aimed to characterize clinical outcomes in AS plus ATTR‐CA compared with only AS or ATTR‐CA. Methods and Results In a retrospec...
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Wiley
2025-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.033251 |
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| author | Ahmad Masri Yong Chen A. Carmine Colavecchia Darrin Benjumea Aaron Crowley Priti Jhingran Matthew Kent Jenifer Wogen Cindi Pankratova Jose Maria Jimenez Alvir Rahul Bhambri |
| author_facet | Ahmad Masri Yong Chen A. Carmine Colavecchia Darrin Benjumea Aaron Crowley Priti Jhingran Matthew Kent Jenifer Wogen Cindi Pankratova Jose Maria Jimenez Alvir Rahul Bhambri |
| author_sort | Ahmad Masri |
| collection | DOAJ |
| description | Background The coexistence of transthyretin cardiac amyloidosis (ATTR‐CA) and aortic stenosis (AS) is increasingly recognized, but the clinical consequences are unclear. We aimed to characterize clinical outcomes in AS plus ATTR‐CA compared with only AS or ATTR‐CA. Methods and Results In a retrospective cohort study, patients with AS only, ATTR‐CA only, or AS plus ATTR‐CA were identified using all‐payer claims data (2015–2021). Eligible patients had ≥1 claim for AS or cardiac amyloidosis (excluding light‐chain cardiac amyloidosis); were aged ≥60 years; and were continuously enrolled in medical plans for ≥6 months after diagnosis. Ad hoc subanalyses were conducted in patients with aortic valve replacement at first diagnosis (surrogate for severe AS). Of 355 430 eligible patients, 345 771 (97.3%), 8453 (2.4%), and 1239 (0.3%) were included in the AS‐only, ATTR‐CA–only, and AS–plus–ATTR‐CA cohorts, respectively; 41 312 (11.9%), 14 (0.2%), and 212 (17.1%) had aortic valve replacement. Two‐year mortality rates were 16.1% (95% CI, 15.9–16.2), 14.8% (95% CI, 13.9–15.7), and 19.2% (95% CI, 16.9–21.8) in the AS‐only, ATTR‐CA–only, and AS–plus–ATTR‐CA cohorts; heart failure hospitalization rates were 29.4% (95% CI, 29.2–29.5), 22.8% (95% CI, 21.9–23.8), and 48.7% (95% CI, 45.7–51.7). AS plus ATTR‐CA was associated with increased risk of death (HR, 1.3 [95% CI, 1.1–1.4]; P<0.0001) and heart‐failure hospitalization (HR, 1.9 [95% CI, 1.8–2.1]; P<0.0001) versus AS alone. In the aortic valve replacement subgroup, AS plus ATTR‐CA was associated with an increased mortality rate (HR, 1.4 [95% CI, 1.1–1.8]; P=0.003) but not heart failure hospitalization (HR, 1.1 [95% CI, 0.9–1.3]; P=0.07) versus AS only. Conclusions Patients with AS plus ATTR‐CA experience worse clinical outcomes than patients with AS only. Increased awareness of these coexisting conditions may help facilitate earlier screening and improve prognosis. |
| format | Article |
| id | doaj-art-6da30d5657774fd0bc6ddeafef039a8f |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-6da30d5657774fd0bc6ddeafef039a8f2025-08-20T03:07:46ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-01-0114210.1161/JAHA.123.033251Coexisting Calcific Aortic Stenosis and Transthyretin Cardiac Amyloidosis: Real‐World Evaluation of Clinical Characteristics and OutcomesAhmad Masri0Yong Chen1A. Carmine Colavecchia2Darrin Benjumea3Aaron Crowley4Priti Jhingran5Matthew Kent6Jenifer Wogen7Cindi Pankratova8Jose Maria Jimenez Alvir9Rahul Bhambri10Division of Cardiovascular Medicine Knight Cardiovascular Institute, Oregon Health & Science University Portland OR USAPfizer Inc New York NY USAPfizer Inc New York NY USAGenesis Research Hoboken NJ USAGenesis Research Hoboken NJ USAGenesis Research Hoboken NJ USAGenesis Research Hoboken NJ USAGenesis Research Hoboken NJ USAPfizer Inc New York NY USAPfizer Inc New York NY USAPfizer Inc New York NY USABackground The coexistence of transthyretin cardiac amyloidosis (ATTR‐CA) and aortic stenosis (AS) is increasingly recognized, but the clinical consequences are unclear. We aimed to characterize clinical outcomes in AS plus ATTR‐CA compared with only AS or ATTR‐CA. Methods and Results In a retrospective cohort study, patients with AS only, ATTR‐CA only, or AS plus ATTR‐CA were identified using all‐payer claims data (2015–2021). Eligible patients had ≥1 claim for AS or cardiac amyloidosis (excluding light‐chain cardiac amyloidosis); were aged ≥60 years; and were continuously enrolled in medical plans for ≥6 months after diagnosis. Ad hoc subanalyses were conducted in patients with aortic valve replacement at first diagnosis (surrogate for severe AS). Of 355 430 eligible patients, 345 771 (97.3%), 8453 (2.4%), and 1239 (0.3%) were included in the AS‐only, ATTR‐CA–only, and AS–plus–ATTR‐CA cohorts, respectively; 41 312 (11.9%), 14 (0.2%), and 212 (17.1%) had aortic valve replacement. Two‐year mortality rates were 16.1% (95% CI, 15.9–16.2), 14.8% (95% CI, 13.9–15.7), and 19.2% (95% CI, 16.9–21.8) in the AS‐only, ATTR‐CA–only, and AS–plus–ATTR‐CA cohorts; heart failure hospitalization rates were 29.4% (95% CI, 29.2–29.5), 22.8% (95% CI, 21.9–23.8), and 48.7% (95% CI, 45.7–51.7). AS plus ATTR‐CA was associated with increased risk of death (HR, 1.3 [95% CI, 1.1–1.4]; P<0.0001) and heart‐failure hospitalization (HR, 1.9 [95% CI, 1.8–2.1]; P<0.0001) versus AS alone. In the aortic valve replacement subgroup, AS plus ATTR‐CA was associated with an increased mortality rate (HR, 1.4 [95% CI, 1.1–1.8]; P=0.003) but not heart failure hospitalization (HR, 1.1 [95% CI, 0.9–1.3]; P=0.07) versus AS only. Conclusions Patients with AS plus ATTR‐CA experience worse clinical outcomes than patients with AS only. Increased awareness of these coexisting conditions may help facilitate earlier screening and improve prognosis.https://www.ahajournals.org/doi/10.1161/JAHA.123.033251aortic stenosisaortic valve replacementcardiac amyloidosishospitalizationdeath |
| spellingShingle | Ahmad Masri Yong Chen A. Carmine Colavecchia Darrin Benjumea Aaron Crowley Priti Jhingran Matthew Kent Jenifer Wogen Cindi Pankratova Jose Maria Jimenez Alvir Rahul Bhambri Coexisting Calcific Aortic Stenosis and Transthyretin Cardiac Amyloidosis: Real‐World Evaluation of Clinical Characteristics and Outcomes Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic stenosis aortic valve replacement cardiac amyloidosis hospitalization death |
| title | Coexisting Calcific Aortic Stenosis and Transthyretin Cardiac Amyloidosis: Real‐World Evaluation of Clinical Characteristics and Outcomes |
| title_full | Coexisting Calcific Aortic Stenosis and Transthyretin Cardiac Amyloidosis: Real‐World Evaluation of Clinical Characteristics and Outcomes |
| title_fullStr | Coexisting Calcific Aortic Stenosis and Transthyretin Cardiac Amyloidosis: Real‐World Evaluation of Clinical Characteristics and Outcomes |
| title_full_unstemmed | Coexisting Calcific Aortic Stenosis and Transthyretin Cardiac Amyloidosis: Real‐World Evaluation of Clinical Characteristics and Outcomes |
| title_short | Coexisting Calcific Aortic Stenosis and Transthyretin Cardiac Amyloidosis: Real‐World Evaluation of Clinical Characteristics and Outcomes |
| title_sort | coexisting calcific aortic stenosis and transthyretin cardiac amyloidosis real world evaluation of clinical characteristics and outcomes |
| topic | aortic stenosis aortic valve replacement cardiac amyloidosis hospitalization death |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.033251 |
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